Birth Story – Cutting the Nuchal Cord

This is the birth story of my son Alex, who was born in an Australian hospital in 2004.

Alex was born with the umbilical cord around his neck (nuchal cord), which was cut before he was born.

Longer than your usual birth story, it includes information and links regarding the injuries sustained from pre-birth amputation from the placenta. This birth story aims to raise awareness of the vital importance of keeping a baby’s cord intact during and after birth – to safely oxygenate the baby and avoid long-term damage.

When I arrived at hospital in labour to give birth to my second child Alex, I thought I was well prepared to have a safe, straightforward birth.

With my first baby I read many books about childbirth and had a ‘normal’ hospital birth without pain medication, where I was cared for by gentle midwives who were reasonably ‘hands off’.

The truth was I had no idea about routine interventions, cord management practices and their impact on the physiology and health of mothers and babies.

There were some differences with my second baby though. I had terrible heartburn and was persistently anaemic – I didn’t know at the time that antacids interfered with iron absorption, even supplements. I had grown much bigger with Alex (he was 2lbs bigger than my first, it turned out) and where I now lived had a much larger, busier hospital.

Stretch and Sweep

It was Friday and I was (an estimated) 40 weeks + 6 days pregnant at my last antenatal appointment. Lying back, the midwife was palpating my baby when I mentioned my last baby was 7lb 10oz but suspected this baby was bigger.

“Oh yes,” she said, “this baby is WELL over 8lbs.” *gulp!*

Back then I hadn’t heard of anyone having a baby bigger than 8lbs. Yes, I have learnt a lot since 2004!

The midwife offered to ‘sweep the membranes’ and I had to ask her what this was. She reassured me it was a simple procedure for women over 40 weeks. “I can’t leave you waiting around this like forever.”

It turns out sweeping the membranes to induce labour can be painful and unpleasant. It certainly was for me.

I was physically uncomfortable from the moment the ‘sweep’ was done – a ‘crampy’ ache began in my lower back and cervix and remained constant. I couldn’t sit or lie down comfortably…so I spent the next two days, Saturday and Sunday, pacing up and down my street in the cold, to try to ease my discomfort or make something of it.

I felt so uncomfortable I was sure labour was imminent and walking would ‘bring it on’. Labour didn’t begin though. I just had the constant cramping, which was painful like a contraction but did not progress into labour. All the walking just made me overtired and I realised if labour started while I was this exhausted I’d be in trouble!

By Sunday lunchtime I had begun to leak amniotic fluid. I called the hospital and was asked to go in for a check up.

“Your membranes are leaking fluid; you’ll need to come in tomorrow night if labour hasn’t started.”The monitoring showed Alex’s heart rate was in the 160s with good variability.

By Sunday night the cramping eased up (thankfully) and I slept surprisingly well for a heavily-pregnant woman.

Labour day – 41 weeks, 2 days

I awoke at 5.00am Monday with a hot, sharp contraction radiating right through to my back.

Woohoo! Real labour!

I was so happy the cramping had finished and the real thing had begun!

It wasn’t long until I couldn’t lie down anymore. I told my husband Paul I was in labour, so he had breakfast and started watching a movie so he wouldn’t get too bored during the early stages.

I was able to eat some toast but by 9am the contractions were regular and I needed my daughter to be collected so I could relax, as well as prepare to leave for hospital at any time.

Contractions were about 5 to 7 minutes apart, but getting looong and strong. I laboured undisturbed at home until midday when I realised I probably didn’t have much longer to go.

Leaving home for hospital

We only lived 2 blocks from the hospital, but it was slow getting there because my contractions were now quite close together. I had to stop for contractions at the front door, on the way to the car, at the car door, as soon as I sat down…you get the drift!

As soon as we pulled up at the hospital I jumped out of the car. I didn’t plan on having another contraction sitting or on my back if I could help it!

I kept my head down to avoid the stares and slowly made my way up to the birth suite, contracting in the lobby, hanging onto the walls in the corridor, horrifying people in the lift!…. Then when I got to the entry of the birth suite the contractions were so strong I couldn’t ring the bell! They were super strong and took a bit of recovering in between.

Thankfully Paul turned up (after parking the car), rang the bell and soon I was in a consultation room. The midwife on-duty asked me to get on the (narrow) observation bed for monitoring. Why are the consultation beds so narrow in maternity wards, unfair really!?

This was the first time during this labour I began to feel a bit off-balance.

The midwife was quite insistent I get on the bed for monitoring and also have a cervical exam to be admitted. This hadn’t happened at all with my first hospital birth. I have pre-existing sciatica that is especially painful during pregnancy, which is why I labour standing up and give birth on my knees.

I wanted to explain this to the midwife but I began to throw up during contractions and struggled to talk at all. When the midwife could see I wasn’t about to comply with her request, she set up the monitor next to a recliner chair and asked me to sit there. Being in this chair was just like the car; coping was difficult and I felt stressed during and after the contractions.

Admitted into birth suite

I was barely talking by now, fully in the zone. Just after 1.00pm I was freed from the monitoring and admitted into a birth suite. It was a sunny winter day and the room seemed very bright compared with the consultation room and hallway.

The midwife asked if I wanted to play some music, saying some women liked this. But my labour was well advanced by now and I wasn’t in the mood for music.

I was able to laugh about being too far along to like anything, and say “no thanks, but I would love a mat on the floor to give birth“.

I stood next the bed, swaying my hips and feeling quite positive that labour might be over soon. Paul was applying counter pressure to my lower back, being careful not to press against the bulging disc in my spine that causes my sciatica *ouch*.

When Paul talks about my labour he says I hardly made a sound. But I was vocalising loudly by now, something tells me he must have been expecting me to be much louder!

The contractions began to ‘double peak’ and I remember thinking they were like every contraction I’d ever had…and the pain rolled into one!…but then all of a sudden I knew the baby was coming!

I dropped to my knees on the mat, with my chest upright and arms braced on the end of the bed. It was just after 2.00pm.

Second stage

I was still wearing underwear and asked for them to be ripped off. I was asked to stand up and take them off, but there was no way I was moving. The midwives cut them off with scissors thankfully.

Baby Alex descended out of the cervix and it felt very quick. The pressure was enormous and I began to bear down during the contractions.

The attending midwife crouched next to me on the mat and said the ‘waters’ were bulging. I couldn’t stand the pressure and asked her to break them for me. I hadn’t asked for an intervention like that before, but she told me it was better if she didn’t.

The membranes ruptured naturally at 2.13pm, and I felt the warmth gush down my legs. What a relief! [The notes state the liquor was clear.] But the relief was short-lived, because this pressure was quickly followed by my son’s head. Argh, he felt huge!

The stretching with Alex was very intense and seemed to happen quite slowly. I focused on not pushing too hard – but waiting for a contraction with his head half out was the worst ‘ring of fire’ ever!

The contraction came and the rest of his head was born. A part of me knew I had just experienced one of the moment painful moments of my life, but it was over!

With his head out, I was waiting for the next contraction. With my first baby there was a slightly-longer break in contractions once her head was born. The midwives had reassured me this was normal last time, so I wasn’t worried about waiting a few moments for Alex to be born.

Nuchal cord

The midwife performed a vaginal exam and announced the cord was around my baby’s neck (a nuchal cord).

She began to push her fingers further inside me and try to loosen the cord by pulling on it. She then informed everyone the cord was tight and looped twice around his neck.

At first the manipulation of the cord at his neck just felt intrusive, but before long the midwife was actually pushing her hand inside me to reach the cord and create some ‘slack’. Leaning forward on my knees, I couldn’t see what was happening behind me. I could feel a hand moving inside me, pushing, and it became excruciatingly painful.

It hurt so badly I felt like I couldn’t breathe. I heard a surgical instrument and started to panic.

“Why am I being cut!” I asked another midwife in view.

She reassured me this wasn’t happening but I couldn’t believe I wasn’t tearing or being cut. The examination and attempts to reach the cord were excrutiating having just birthed the head – pain was radiating throughout the vaginal, perineal and rectal area.

I have no doubt that shock and adrenalin from this unexpected intervention caused my contractions to stop dead.

So now I have lost the urge and ability to push out my baby – all I want to do is stand up and get away from the midwife. But I feel trapped. I’m mute.

All this happened immediately after his head was born. The midwife didn’t wait to see if my son could rotate and deliver normally. She intervened as soon as she saw the nuchal cord.

“I can’t unloop the cord. I’m going to have to cut it.”

The noise and feeling of surgical instruments was actually the cord being doubled clamped in order to ligate the cord.

Alex was only half born when he was amputated from the placenta – cut off from his organ that provided him oxygen, transfered accumlated wastes and contained the blood supply for his transition at birth.

What the evidence says about nuchal cords

It was years after Alex’s birth before I found an article about safely managing a nuchal cord – it clearly stated to leave it alone.

I read the worst thing you can do with a nuchal cord is cut it. I learnt nuchal cords are common and that babies can still be born with a tight nuchal cord. In water the babies gently loop through the cord or curl out of their mother’s body (instead of straight out). On land the birth attendant or mother can support the baby to curl or ‘somersault’ out if the cord is tight or not long enough. (1)

I understand the midwife responded to the presentation of a double nuchal cord based on her training, experience and work practices. Obstetric, nursing and midwifery textbooks are full of unevaluated recommendations to unloop or cut nuchal cords. But they are not accompanied by any references to scientific evidence to support these interventions. Instead, scientific literature contains case studies of catastrophic birth injuries and recommendations by medical researchers and practitioners to leave the cord intact before and after the baby is born.

With a baby half-way out of me I was extremely vulnerable to the actions of others. And, growing up on a farm where the cords of other mammals were NEVER clamped to ensure the birth was safe, I had no idea that birth attendants would amputate a human baby from the placenta before birth.

I was never asked to consent to being examined for nuchal cord, nor given time to consent before the cord was cut. It is vitally important that a birthing woman is informed prior to any procedure and asked to consent. It is also the law.

Cord already cut, baby not yet born

Once the cord was cut there was immediate panic by the midwives for him to be born. I started to push without a contraction but I was shocked to realise his body didn’t budge at all. I tried to push again but there was no strength without a contraction and baby still didn’t move.

The midwife explained I needed to rush and asked me to push again. All I could reply was “I can’t, I have to wait.”

The room became very quiet. I stared straight ahead and mentally tried to block out what had just happened. I felt like my pelvis needed to open wider so Paul helped me to raise my right knee up and out. The seconds felt like a lifetime and I wasn’t sure how long it had been since my son’s cord had been clamped…but thankfully the urge to push returned.

With the first push I felt Alex turn – his shoulders hadn’t rotated yet which is why he didn’t move before! I then pushed as hard as I could and his shoulders ‘exploded’ out of me. Ouch.

I remember the midwife telling me she was injecting me with something but I didn’t feel it [syntometrine].

Response at birth

Alex was born at 2.24pm.

He was a big baby and a tight fit in the birth canal.

Given the fetal heart rate recordings, it is fair to assume the cord around his neck was not tight during labour. The monitoring didn’t show up any problems with Alex’s blood flow during contractions. But the cord had tighten significantly by the time his head ‘delivered’ – before the shoulders.

When the cord was tight it was compressed and being a big baby, his body was compressed too. The umbilical cord was clamped during this compression and resulted in significant blood loss being inflicted on my baby.

It had been an intense three hours of active labour – with my other babies I have felt immediately happy and relieved after giving birth. Not so with Alex.

Paul clearly remembers our baby ‘dropping’ straight out of me, being picked up by the midwives and instantly raced to the bed in front of us.

The midwives ‘flopped’ Alex outstretched onto the bed. Paul joined me and together we watched, stunned, while the midwives began to resuscitate our limp, watercoloured-grey baby.

I tried to reassure myself and Paul – who had his hand clasped over his mouth – that newborns don’t always start breathing straight away.

At the time, I didn’t know that compression from the nuchal cord may have already blocked the flow of oxygenated blood to Alex even before the midwife clamped the cord. I didn’t know the need to resuscitate him was caused by the ‘management’ of the nuchal cord.

His resuscitation was due to him being depressed by the tight cord and then the clamping, which prevented any chance of him receiving the placental blood transfusion that normally occurs in the minutes after birth with an intact cord.

Simply unlooping my son’s cord after he was born would have facilitated a safer transition and possible ‘auto-resuscitation’ by restoring his blood volume, perfusing all his organs with adequate blood, including his lungs, and supported his transition to breathing.

My baby was most likely suffering from a low blood volume – administration of oxygen does not fix this. Studies of blood volume have shown that a nuchal cord can result in a blood loss of between 30-50% with immediate cord clamping.

My baby’s blood was trapped inside the placenta, only to be later discarded.(An engorged placenta can also complicate the separation of the placenta from the uterus and increases the mothers’ risk of haemorrhage.) (2)(3)

Watching the resuscitation

I watched my pale baby being worked on by the midwives. I saw his floppy arms and legs flailing as the towel was rubbed vigorously over his body.

I saw the thick black meconium streaked down the inside of his legs (the baby’s first bowel movement).

I remember thinking “please don’t let my baby die; I just worked really hard to get him”. It felt like such a long time before his colour began to change.

[His notes state that he took 3 and half minutes to establish regular respiration – his resuscitation included tactile stimulation, suction and oxygen, IPPR bag and mask.]

The situation seemed to be stressful for the midwives too; the delay in him being born after the cord was clamped had raised the stakes of a poor outcome.

Once he began to breathe, Alex he was moved to the other side of the room and worked on by more people, where I could no longer see him.

Alex’s first Apgar score was 4 (at 1 minute) and then only 6 (by 5 minutes).

[Alex’s birth records state:
“Head did not rotate, therefore traction applied to deliver shoulders as colour fetal head becoming cyanosed in appearance. Shoulders emerging transverse and were rotated to AP just prior to birth shoulders. Cord around neck loosely and pulled down. Blood taken for cord gases.”

No mention of the pre-birth cutting of a tight nuchal cord!?!

The events of my son’s birth are not captured in his birth records. When my son’s condition was reported to the doctors, there is a good chance they didn’t know he had a tight nuchal cord and was at risk of hypovolemia. Does this explain why he wasn’t checked or treated for anaemia?

Placental birth

I didn’t give birth to the placenta. After a short, spontaneous and natural labour, the pre-birth cord clamping had ‘terminated’ my attempt at natural birth and ‘pathologised’ the third stage of labour.

While other staff continued to work on Alex, I was asked to get on the bed for active management of the placenta.

I remember my backside was hurting so much I didn’t want to lie down! The midwife placed a metal dish between my legs and started to take the clamp off the cord attached to me still. I looked away at this stage to watch the staff working on Alex.

It was years later I realised what the midwife was doing – and why I am SO glad I looked away at this point. She was unclamping the cord to drain the excess blood out of the placenta – MY SON’S BLOOD! – before she began applying traction on the cord. I feel absolutely sick thinking and writing about this.

The midwife began to roll her fist into my stomach, pushing in quite deeply. The “active management” felt rather rough. The cord was pulled on pretty hard for quite a while, in between pushing down on the uterus.

“The delivery of the placenta must be completed before the uterus, under the influence of large amounts of oxytocin, contracts sufficiently to trap the placenta behind the closing cervix. Once the injection is given, the placenta must be delivered within 10 minutes to prevent this happening.” (4)

The obstetric discharge summary says the third stage took nearly half an hour.

Having your uterus pummelled after giving birth feels awful. I was starting to get really sick of this woman hurting me, especially because I didn’t understand why. I felt so shocked, weak and passive. I wasn’t talking or asking questions, things were just happening to me and around me.

9lbs 10oz – without placental transfusion

I heard the staff weigh Alex and announce he was 9lbs 10oz with a big head! I agreed with that!

If Alex had even a minute or so of placental transfusion at birth, he probably would have weighed around 10lbs. In case you’re wondering, I was tested and didn’t have GD. His father is 6ft 4 and was a big baby too.

The buzz in the room indicated they thought he was large and their discussion turned to testing him for low blood sugar. “He’s sure to be hypoglycaemic.”

Alex was tested and did have low blood sugar levels, but not necessarily because of his size. Low blood volume from cutting the cord is invariably linked to low blood sugar.

Ragged membranes

When the midwife was able to ‘remove’ the placenta, she inspected it in front of me.

The membranes had torn in several places and she informed me they could still be inside my uterus. A quick vaginal inspection showed I had a small tear but I quickly told the midwife I didn’t want to be stitched. I couldn’t stand the idea of being handled anymore.

The midwife told me I was brave to birth like that without any drugs. She patted me on the leg and announced to the room that I “was a tough one”.

First moments with Alex

Baby Alex was placed, tightly wrapped, on the bed next to me. All I could see was his scrunched up face.

I gazed at him, feeling more shock than awe. He didn’t open his eyes and he even looked a bit strange to me.

Where were my feelings of recognition, my connection?

We were together for a very short time before he was checked and the staff noticed his nostrils were flaring.

They quickly picked him up again and explained he was having trouble breathing and needed to go to the Special Care Nursery. And he was gone.

My minute with Alex before he was taken for treatment for respiratory distress

Special Care

Alex’s discharge summary states he required treatment for hypoglycaemia and transient Respiratory Distress Syndrome due to meconium stained liquor.

It is a shame my son’s condition at birth and respiratory distress were not recognised as insufficient blood volume (hypovolemia) from prematurely cutting his cord. Instead it was attributed to his size and meconium stained amniotic fluid – except the liquor was clear. The meconium was probably passed during the second stage after the cord was clamped.

I read an article by a doctor recently that describes what may have happened to Alex during his birth, (although my baby was not this critical, he still had a good heart rate and did improve upon resuscitation):

“The most frequent cause of fetal distress is cord compression (cord around the neck, knot in the cord) that impedes cord venous flow and congests the placenta with a large amount of oxygenated blood. At birth, this child is not only hypoxic but hypovolemic. The clinical appearance is a flaccid, limp, pallid child with a very slow heartbeat. Immediate clamping in the panicked rush to resuscitation leaves the newborn with insufficient blood volume to perfuse either the lungs or the brain adequately. Ventilation fails to improve the Apgar score while a placenta engorged with oxygenated blood is discarded.” (6)

Alex’s continued respiratory distress was most likely due to insufficient perfusion of his lungs and low blood volume that risked organ damage, including the brain. He needed his blood that lay to waste in the placenta. The blood loss from clamping a tight nuchal cord can also cause low body iron levels – which are associated with damage to long-term brain development:“Iron deficiency in the first few months of life is associated with neurodevelopmental delay, which may be irreversible.” RCOG paper 2009 (7)

[Special Care Notes –

Baby came to SCN for observation following delivery. Baby Large for Gestational Age (LGA) 4.380kg. Observations Temp 36.2, Heart Rate 102, RR 19 SaO2 92% Nasal flare and rib retraction. Baby slightly cyanosed. Meconium present on legs. At 5.00pm his O2 sats were 96%, ten minutes later he had slight central cyanosis. (There are downward arrow next to the sats, but my doesn’t show the actual percentages. Under the warmer his temp was 36.5.)]

Alone in the birth suite

Paul and I were left alone in the birth suite. I had a shower and was surprised at how much blood I kept losing. While getting dressed I had to change my pad and underwear three times because I was bleeding through before I could get dressed.

I got back into the bed feeling completely spent, with no baby.

My mother arrived to visit with my daughter and I was happy to see them. But it felt strange because there was no baby to introduce them to.

I was relocated to the maternity ward, where I had more family and friends come to visit. They asked me about the birth and I could feel my body start to tremble as I told them it went fine until they found the cord around his neck and ‘had to cut it’.

Nobody said much about it, I don’t think any of us really understood what had happened or the ramifications.

Special Care Nursery

At 7.00pm I was informed I could see Alex in the Special Care Nursery. It was nearly four hours since I had seen him, for that brief time on the bed.

The hospital was quieter now and he was the only baby in the SCN.

The nurse there was an older woman and she seemed really nice. She sat me down and handed Alex to me, who was still bundled up in a lot of blankets.

She explained that Alex needed to be given formula but that I was welcome to breastfeed him first. There didn’t seem to be any choice in the matter, I was just told the formula was medically necessary. The nurse asked if I knew how to breastfeed and I replied yes, I was confident after 3 years experience with my last baby.

Alex was bundled up in so many blankets it was hard to align him to my chest. I tried to unravel the top of the blankets a tiny bit but the nurse reached over and closed them up again. “He is very cold, you must keep him warm.”

The lights in the room were so bright and I still hadn’t seen my baby’s eyes. I asked if Alex had opened his eyes yet and the nurse said no. He was approaching 5 hours old!

Feeding Alex – watch out for the nipple pincher!

I turned my back to the nurse slightly and opened my shirt. I didn’t want to rush the feed; I wanted to see if I could stimulate some instinctive behaviour in my baby. Up until now the only movement I had seen were his nostrils flaring earlier.

I started by gently brushing my nipple on his cheek, near his nose and mouth. He began to stir and open his mouth. I kept stimulating him and I could feel my spirits lifting as he rooted for the nipple. *Yay, he can move more than just his nostrils*

But all of a sudden the nurse bent over the top of my chair, pinched and stretched out my nipple and forcibly pushed my baby’s head onto it.

Talk about ruin the first special moment I’d had with my baby!

Remembering this makes me so mad. She had no right to touch me like that and there was no cause for the interference. The nurses actions were so rough she caused a ‘crack’ in my nipple. Unfortunately I have heard from other women with similar experiences at this hospital – the nipple pincher is either still at large, or it is standard practice there!!

Alex hadn’t latched when his face was smooshed into my breast (surprised?) so I hunched over him so the nurse couldn’t see him and let him attach himself a few seconds later.

Alex wasn’t able to feed for very long before he fell asleep. I left the nursery in disgust knowing he was being fed formula and feeling terrible I couldn’t just take him with me. My nipple hurt too!

Thankfully it was only another hour before Alex was able to leave the SCN and room-in with me. He was wheeled in to my room at the end of the ward, in a clear plastic tub. I was told I must used the ‘tub’ to move Alex around and to keep him warm at all costs.

He looked pale but seemed content. Finally we were alone.

Alex – day 2 after birth

Sneaking my own baby

Near my room, at the end of the ward, was a small waiting room.

At 9.00pm the room was barely lit, only by the soft corridor lights. I picked up Alex out of his ‘tub’ and walked to the doorway to check if there were any nurses around. Sneaking off with my own baby, I went into the waiting room and sat down on one of the couches not visible from the hallway. Still wrapped, I held Alex out in front of me and spoke to him. “Hello baby!”

He instantly opened his eyes and looked straight at me – his eyes were blue! We saw each other for the first time nearly six hours after he was born.

Hospital stay

We ended up staying at the hospital for two days.

I had heavy bleeding and needed assistance to remove the ‘ragged’ membranes.

(In fact, the heavy bleeding persisted for over 12 weeks. I required an internal ultrasound at 10 weeks which didn’t find any cause for the prolonged post-partum bleeding. Turns out active management is not always so great for maternal blood loss!)

When the nurse removed the ragged membranes I began to tremble again, like I had when talking to my family about Alex’s birth. Only this time the trembling turned into intense shaking. I didn’t know why it was happening and felt embarassed. I wasn’t in physical pain but I now think it was a reaction to the trauma of the birth.

But now that Alex was rooming-in with me I felt so much better. He slept in my arms and on my chest, healing me.

Alex breast fed very regularly, but he was weak and couldn’t nurse for very long. His strength and ability to feed slowly improved over time. I’m pretty sure he vomited up most of that formula he was given the first night to ‘treat’ his hypoglycaemia, which meant I didn’t sleep a wink in case he choked. He seemed to ‘spit’ it up for hours.

I don’t know how digesting infant formula in the first hours of his life while suffering from low blood volume was good for him. A blood transfusion, colostrum and his mother’s body heat would have been a much better start, considering what his birth injuries were.

Once we were home I was able to continue bonding with my baby. In the warmth of home I got to see and touch his skin, carry him and breastfeed him almost constantly until he gained enough strength to feed more vigorously. He grew into a gorgeous toddler and was adored by his parents, big sister, grand-parents and extended family.

Alex as a toddler

The aftermath

In the weeks and months following his birth, thinking about Alex’s birth still caused me to start shaking, so I tried to push it out of my mind. I knew I never wanted to give birth again and my husband arranged a vascectomy soon after Alex was born.

Alex’s physical development was impressive. He sat, crawled, stood and walked at a much younger age than his big sister. I thought his birth experience was completely behind us, until by age 3 it was clear he had developed disruptive and compulsive behaviours (constantly running off, breaking his toys). I also discovered it was difficult for him to concentrate and learn to read and write in preparation for school. His parents and sister all did very well academically in primary school, so I hoped starting school might develop his interest.

After a year at primary school Alex was referred to a paediatrician based on my concerns and his school. He speaks in incomplete sentences, is testing well below the expected levels and has difficulty behaving appropriately in formal learning environments.

Alex has been diagnosed severely autistic, with anxiety and learning delay.

Alex, school age

There are passionate debates about the causes of autism – and about the optimal time of umbilical cord clamping.

While I do not believe that cord clamping (or vaccines!) cause autism, I recognise that studies of children with autism do not measure for premature amputation from the placenta, altered blood volumes and reduced stem cells. I have also read studies where the need for resuscitation at birth was associated with lower IQ scores by school age.

I do think the events of my son’s birth have had an impact on his young brain, his ability to learn and to express himself.

For anyone who feels profound regret about their child’s birth, you know how I feel when I admit to wishful thinking, wishing I could go back and change what happened.

While I cannot change what happened to my son, maybe my story can help others be aware of the trauma that can be caused by cord cutting, and the importance of the cord being left intact while their baby is born and transitions to life outside the womb.

I believe that outcomes for mothers and babies would be much improved if it was standard practice that any person who clamps a cord, particularly before placental transfusion and the baby establishing respiration, is individually responsible and liable for the resulting injuries.

Thank you so much for sharing Alex’s birth story & your continuing journey.

I am currently a midwifery student who also had an extremely traumatic birth experience nearly 15 years ago.

I am hoping that I can make a difference.

It is terrible that your journey with Alex was so traumatic and you are still living with the consequences. I sincerely hope that some excellent strategies are found for you & that your precious little boy moves forwards in great strength.

Kate, thank you so much for sharing – your story is compelling reading and so powerful. Everyone who has anything to do with childbearing women needs to read this and think about the implications of everything that happens during labour and birth. Your experience and your descriptions have so many lessons for us birthworkers, I hope students and midwives alike read and take your words to heart. I hope women and their partners find your story and learn the lessons well before they get into a place where the knowing is advantageous. Getting the information to those who need to read it means this post must be shared over and over again. Thank you so much.

I do hope you find the help for your sweet child that helps him achieve his full potential. Please keep in touch. Gratitude and much love to you, Carolyn

Hi Carolyn – I was blown away by your support and to see you have shared this story through social media. I’m sure it was part of having over 1700 people read it in three days!
I too hope that identifying the best techniques to assist Alex with learning he can keep moving forward. He is a very happy and healthy boy. I will keep an eye on your blog and sm pages, the articles you share are fantastic.

A gutwrenching story Kate,congratulations on your career choice, you will make a great doula.
A lot of women and their babies will have much happier birth stories/outcomes because of your assistance.
Keren

Hi Keren, I know what you mean by gut wrenching. Since sharing this article I have met other mothers online who experienced the same management of a nuchal cord – quick to pull and quick to cut. It was gut wrenching for me to learn about other women’s experiences and babies that fared worse than Alex.
Thanks for reading

My daughter had the cord wrapped around her neck twice at birth. From memory the rest of her body was born rather quickly after her head emerged. I clearly remember the midwife saying her body ‘somersaulted’ out just as they were freeing the cord, though I don’t think this was a planned maneuver, just that she was ready before the midwives were! A delayed cord clamping was something I strongly desired for my baby and so thankful I was not presented with a situation where I would need to fight against the staff to achieve this. I truly hope the delayed cord cutting soon becomes the norm.

Thank you for sharing your story and helping to create awareness on this topic. It’s great that your story is being read by so many and I wish you the very best with it all.

Hi Holly, so pleased to hear your daughter navigated her cord and care providers in such a safe manner :-) Part of the reason I shared this story was to contribute to the advocacy for leaving a baby’s cord intact. Glad to hear your baby got the benefit of her birth right/ blood!

My youngest son was born 2 weeks early after a worrying third trimester with reduced fetal movement. We’d had monitoring and experienced one decel, but he managed to pass the other time so they pit it down to temporary cord compression. After each monitoring I was unhappy, my baby didn’t behave the same way my others had (he was mu 14th), And though he ‘passed’, I wasn’t confident he was alright.

Going into labor two weeks early was unheard of for me, my pregnancies had got ptogessively longer with my 13th going 10 days passed due. I labored all day and baby was more active than usual. We headed to the hospital when I felt birth was imminent. In hospital I remained active, walking and rocking and I spent a lot of time in the shower. As second stage began I climbed onto the bed, kneeling over the back to deliver the way I had with my last 8 babies. After some hard pushes the membranes ruptured and meconium was seen, my mw turned to push the emergency button and then turned back to see my son land on the bed. I was urgently told to lift my leg and turned to se her unwrapping little Eli from his cord. It had been wrapped around his neck not once or twice but four times! We then discovered a true knot in it.

He was fine, his apgars were 9 and 9 and he weighed in at 6lb 6oz. My appear baby. My biggest had been 9lb 12oz so he seemed so tiny.

His story is proof that cutting a nuchal cord isn’t necessary, I guess his fast birth made it impossible anyway, nut his story also is warning that drs and mws should always listen to a mothers concerns, especially one who has experienced pregnancy before. It is believed that Eli may have been swimming in mec for weeks before his birth and I believe that his growth had been restricted.

Hi Michelle – a pregnant woman’s intuition is amazing isn’t it?! Sounds like Eli had a generous cord he got to swim and loop around like crazy in there! :-) I’ve only seen pictures of a true knot, glad your son was able to birthed safely and cord intact!
Thanks for commenting

Thank you for telling your story, i am also a midwifery student and your story highlights to me the importance of explaining actions before they happen. I think it would have been valuable for you and the midwives involved to have had a non blame debriefing experience with you, because im sure they were probably as terrified at the experience as you were and everyone couldve learnt from the experience. I wish you the best of luck with your beautiful little boy!

Hi Kristy, good luck with studies and training. A debrief might have been a good thing, you’re right. Only given the way the cord was managed it was probably based on older training that emphasised that the nuchal cord causes the problems/ is an automatic problem, rather than the way it was managed. When I look back the follow up I would have preferred would have been a doctor to speak with me about his red blood cell count, anaemia and why he was so lethargic. I can’t go back there though, which is why the story is being shared with midwives and OBs.
Cheers

Gosh! Your post took me back 16 years to the birth of my second child. She too had the cord tightly around her neck twice. Our outcome was different to yours as C was born immediately after the cutting of the cord. I had no idea about the risks of what the MW was doing, I simply did as I was told. I was frightened and tired and thought that there was no other option. C had a blood transfusion that night as she had lost a lot of blood.

My heart goes to you (now that it has come out of my mouth). I am sure that this experience will help with your work as a midwife and that you will be one of the ones to praise.

Much love to you and your family, and I’m sorry for the time that you lost with Alex.

Thanks Mars, can I just say how much I love your blog and MammyDoula facebook page! I’ve been following your posts for many months and love what you do. I searched YouTube for videos on nuchal cord management not long ago and saw several that just showed how to clamp and cut – and can I say the newborns involved in live examples looked nothing like the babies in most other birth videos. They were extremely limp and pale, just like our babies! I’m sorry your birth was interrupted and your daughter was injured by this procedure too. I am pleased your baby was at least treated with a blood transfusion as I’m sure it would have helped minimise the risks of long term developmental delay from low iron. Thank you very much for sharing the story and your support.
K

When my son was born he had the cord once around his neck. The mw attempted to unloop it (by taking it over his head) when his head was ‘out’, but the rest of him was not. The cord snapped. All I know is that there was some strong tugging as he was pulled free from my body, and there was a lot of blood. Nobody said anything to me about any of the possible consequences you mentioned. I had no idea. Fortunately he was deemed to be ok and I was able to have him with me from birth, so he was able to breastfeed. However, he was an incredibly difficult baby – constantly crying and not sleeping laying down for almost a year. In fact my discharge notes stated, in large capital letters ‘DIFFICULT BABY’. He also had digestive problems. Today he seems to be a generally happy little boy but he does not always exhibit ‘usual’ behaviour, and can be quite obsessive and compulsive and does not cope with change well at all. He is, without doubt, hard work. His speech was considerably delayed, although he has now caught up it seems. I always felt that he had been traumatised by his birth, and having read your story I am concerned that perhaps some of his behaviour may be related to this. Obviously I love him to pieces, and I will continue to do my best to support him. I just wish they had left him alone when he was born – maybe he wouldn’t face some of the difficulties he now has to deal with.

Dear Fawn – I’m very sorry this happened to you and your son. The article linked in the story by MidwifeThinking describes this very thing, with the tension on the cord causing it to snap. This is why it is better to not touch the cord unless needing, and to do so very gently. Of course I cannot say if the blood loss caused gastrointestinal and developmental problems but these were covered in the literature I referenced about hypovolemia. Is there a pediatrician you might be able to talk who would review his birth with you? We share the exact same feelings about loving our sons dearly and wishing their birth has not been needlessly disturbed causing injury. My heart goes out to you Fawn, thank you very much for sharing your experience with me.

I am sitting hear crying, reading your story. 14 years ago my son was born with his cord wrapped loosely around his neck. I am sure now that it would have been clamped straight away. His first night of life he spent in the nursery under heat lamps as he wasn’t maintaining his temperature. I was told it was just ‘one of those things’ that happens with newborns. We had a lot of trouble establishing breastfeeding too. With hindsight, I know that he never received all of his placental transfusion. While he was growing up, I knew that he wasn’t quite like all the other kids his age, he was like a little professor, with a reading age way beyond his peers. It really wasn’t until he hit high school and puberty that problems became very noticeable. He has just been diagnosed with Inattentive type ADD. It absolutely breaks my heart that this could have been prevented. I was young and naive and put my trust completely in the hands of the hospital and I feel hopelessly guilty.

My daughter was born 11 months ago and it was only while pregnant with her that I learnt about the damage of premature cord clamping. Her cord was not clamped until it had completely stopped pulsating and we had skin to skin contact for over half an hour before they quickly weighed and measured her and handed her back to me. I have such a strong bond with my baby girl.

I know far too many parents with children who are ADHD / Autistic, etc and it breaks my heart and makes me furious to know that all of this should have been prevented. It is so hard for me to fathom why premature cord clamping is performed at all.
Far too many people defend their child’s birth because they don’t want to believe that was responsible for damaging their child :(

Our history tells us to be extremely cautious with unproven interventions and drug use (thalidomide being one example) and I believe the epidemic of “rushing” birth (inducing, immediate clamping, plus speeding up placenta in healthy women) will be another legacy we regret.

I’m very pleased you were able to experience a natural third stage and bonding with your baby daughter – it really is natures reward and so important for the making of healthy human beings

Oh wow. Alex’s birth story had me sitting on the edge of my seat. He’s such a lucky boy to have such a positive outcome from his very adverse entrance. I’m sorry you and your family experienced that Kate.

Wow, I could feel how difficult your story was for you to write. I just want to hug you. And Alex as a toddler looks remarkably like my firstborn as a toddler! Although she’s a redhead, he looks almost ginger there.

Thank you for sharing your traumatic story. Two of my four babies were born with long cords around their necks (one boy, one girl). Both were born quickly without interference. My son was born spontaneously while seated during my homebirth, so no time to interfere. His cord was like a skipping rope although I am insure how many time or how tightly it was wrapped. My youngest was born in hospital. I was upright on my knees when her head was born. The Dr/nurses urgently told me “Push, push, push”. I did not know why but did and her body was born as well. The cord was cut earlier than I wanted (Doc forgot to wait longer like I asked) but it was a minute or two later (I had turned over to my back already). So strange to me how there are so many routine interventions not discussed in prenatal care. I understand not wanting to scare people, but in the moment there isn’t really time to receive informed consent.

It makes me angry when mothers crucify medical practitioners who are just doing their job, that is SAVING the life of your child. Tell me please, in detail , what you think WOULD have happened if you were , say, to birth at home with no intervention?
God forbid, your child would have had compressed cord to the point of brain injury because no one was there to force the baby out quickly, then the baby would have been born ‘floppy’, then no one would know how to resuscitate it (as the evil drs and midwives with their evil life saving resuscitation equipment are not present).
Then your child went into respiratory distress (rib recession and nasal flaring), and you probably would have done nothing about it, because you didn’t know .
Give the medical practitioners a break. They were just trying (and succeeding) to save the life of your baby.
Maybe your baby couldn’t summersault out? What then? We wait for the baby to get brain injured for the sake of keeping your cord intact.
??????
Thank goodness for medical practitioners intervening to SAVE little lives when necessary, and when a baby is looking white Or cyanosed it’s certainly time to ACT.

Amanda – I can see from your response that you didn’t actually read this birth story nor the links to the scientific evidence? This is because you are regurgitating the unevaluated recommendations found in medical textbooks from the 1970s. You’re angry at me for crucifying medical practitioners? No, I am extremely critical of nuchal cord management that is not evidence-based and was introduced without regard for the normal physiology of birth (birth, placenta, cord, placental transfusion, newborn transition).

You have asked me to tell you in detail what would have happened if I accidently gave birth to Alex unassisted?

This is actually a very cruel thing to ask me to do. You don’t think I haven’t punished myself many times, thinking about the ways I could have protected my son’s entrance into this world and protected his brain? The brain he must live with for his entire life?

If Alex was born unassisted, there is a much greater chance he would have been without the injury of a severe blood loss at birth and pathological transition.

On what do I make this assessment in hindsight?

*The recorded FHR for Alex showed his heart rate was perfectly fine during the 6 minute second stage – his heart rate was perfectly fine before he was amputated from the placenta, at a point where his body and cord were being compressed and blood volume is temporarily greater in the placenta than the baby.

*This is reasonable evidence that the cord only tightened as his head was born, and before his shoulders delivered.
(This tightening is temporary and partial – the best way to relieve this compression in normal birth is for the baby to be born, not by permanent ligation of the cord!)

*My contractions were close together and very effective UNTIL I had a hand pushed into my vagina with a baby half born. This would not have happened in an unassisted birth, so it is reasonable to expect the contractions would have continued as they were before and after the dangerous disruption.

*No one forced my baby out of my body – once I got people to stop causing me pain, my contractions returned and I pushed him out. This would have happened sooner and much safer in an unassisted birth.

*In Alex’s case, there was plenty of umbilical cord left hanging from my body and his. So again, our physiology/anatomy was favourable for birthing easily and without the iatrogenic complications. In fact, studies out of China have shown that multiple coiled nuchal cords are commonly associated with very long umbilical cords. It is theorised the extra movement encourages longer growth.

*Many many babies are born “temporarily” flat from a “temporarily” compressed umbilical cord and compressed body in the birth canal. This is only one of the reasons why giving birth without drugs is important to me – for the role that endogenous hormones play in protecting the baby from the short-term hypoxia of birth (not to mention stem cells too!). I also understand newborn physiology and understand the role of the placenta, uterine contractions (and hopefully gravity) in quickly equalising the infants blood volume and reperfusing the baby with oxygenated blood. Alex would have been born easily with no assistance – the cord was plenty long enough to be easily unwrapped. The last-minute compression would have been relieved and he would have received a large volume of blood within 15 seconds of being born.

In your experience Amanda, have you ever seen a baby with temporarily cord restriction able to auto-resuscitate attached to the placenta still, like it is supposed to in normal placental-mammal birth? You have never seen it, so how can you understand it? You see white babies amputated from their physiologic source of whole blood and think it is helpful. How does iatrogenic hypovolemia and vasoconstriction help a flat baby to expand their lungs, erect the alveoli, create an oncotic pressure to clear lung fluid, have a healthy blood volume/blood pressure and transport oxygen to all the parts of the baby’s body? “Let us use our brains on this one?”

Amanda, you may not realise how insensitive your comments are that my baby MIGHT have had a compressed cord to the point of brain injury. HE DID!!! The absolute compression of the surgical clamp!!! You said he MIGHT have been born floppy and had rib recession and nasal flaring – HE DID, from the insufficient blood volume from premature clamping of a tight nuchal cord. If you search pubmed “tight nuchal cord and hypovolemic shock” you will see the studies and case studies describing this.

I know how important it is for you to think that the medical practitioners were doing the right thing and were saving my baby. Unfortunately, there is not ONE study to support your position – if you can find a scientific study that shows clamping and cutting a tight nuchal cord is necessary or beneficial please share it here for us to discuss. Despite your beliefs, the evidence shows it causes HARM …I learnt just recently this unproven intervention killed an infant in the UK a few months back (discussed by medical practitioners, not the mother).

As I stated in the beginning of my response, it is clear you did not read the information actually provided in this birth story. There is no way you read the links to the literature reviews on nuchal cord management and the recommendations from medical researchers and medical practitioners to leave the cord intact during AND after the birth. Particularly if the baby needs support or resuscitation.

1991, Schorn and Blanco recommended use of the somersault technique to facilitate birth where the umbilical cord is short or looped tightly around the neck, in order to avoid clamping and cutting the cord.

1994, Iffy and Varadi ‘Cerebral palsy following cutting of the nuchal cord before delivery’ : documenting five cases of pre-birth cord severance followed by a delay in delivery ranging from 3 to 7 minutes. The authors wrote:

“All of these infants were born with a low APGAR score. Subsequently, they displayed manifestations of cerebral palsy and two of them also had permanent brachial plexus lesion. This series of incidents indicates that an unexpected arrest of the shoulders may inadvertently compound the problem that the severing of the cord prior to the delivery of the body entails.”

1999, Reynolds published a family physician practice tip for performing the somersault maneuver, describing it as a “simple way to assist in the birth of a baby with a tight cord”.

“…following the delivery of the fetal head, the physician electively cut the nuchal cord of the fetus… The writers conclude that the practice of severing the umbilical cord prior to the delivery of the body of the fetus, proposed in some textbooks as a routine procedure, is a dangerous technique, which should be avoided. They also point out that the medical literature has not discussed this problem.”

“Cutting the umbilical cord before birth is an intervention that has been associated with hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. This article proposes use of the somersault maneuver followed by delayed cord clamping for management of nuchal cord at birth and presents a new rationale based on the available current evidence.”

2007, Reed ‘Nuchal Cords: Think Before You Check’, :

“Given the lack of evidence to support cutting a nuchal cord, and the medico-legal evidence against, this procedure could pose a risk management problem for practitioners and Trusts.”

2008, Singh and Sidhu ‘Nuchal Cord: A Retrospective Analysis’:

“…having tight cord around the neck had significantly higher proportion of fetal distress and low Apgar scores at one minute…[the definition of tight cord in this study] When the nuchal cord had to be clamped and cut before delivery, it was called “tight”.”

“Immediate cord clamping maintains the hypovolemic state by preventing the physiologic and readily available placental blood from returning to the infant. Loss of this blood initiates an inflammatory response leading to seizures, hypoxic-ischemic encephalopathy, and brain damage or death.”

Brilliant response to Letususeourbrainsonthisone (Amanda?), Kate. The best way to fight individual and institutional ignorance (and snark) is with an informed, calm response. You presented a perfect case. Who knows if she’s even read it though, as she hasn’t returned or shown the decency to respond.

I am 39 weeks pregnant with my 3rd child. My second child was born with the cord tightly wrapped around her neck but I was very fortunate to have a very experienced midwife in with me (my daughter was the last baby she would deliver in her career) and she loosened the cord as soon as my daughter was born. She too was floppy and not the right colour but the midwife waited til the cord stopped pulsating before cutting it and getting the medical team to look after her. After reading your story I am now truly thankful for this midwife as I have always felt and feel now even more grateful to her for my daughter being here today.
Like I said I am 39 weeks pregnant and I have learnt so much from your story. I will now DEMAND to not have the cord cut until I feel it is time amongst other things. My sister is my birthing partner and I have given her strict instructions on what I do and don’t want.

Dear Kate,
Thank you so much for sharing. We had a very similar experience when our son, Oliver, was born in 2006. He also has a diagnosis of ADHD and Autism Spectrum Disorder. You have expressed the truth that I did not have the words for.

Just wanted to thank you for posting this. I had the same EXACT thing happen with my daughter 6 years ago. Cord was declared too tight to deliver after head was out, the doctor clamped it and cut it on the perinium and then screamed like a maniac for me to finish delivering. She was born blue and limp. She now has ADD, anxiety and learning delay. Her two siblings seem fine so far. There’s obviously no way to prove that is the cause of these issues, but it has always been in the back of my mind. I have only recently started searching for other cases of this happening and now realize how rare of an event it really is. The OB who delivered my daughter passed away from cancer months after my daughter was born so I cannot even ask him. I’ve seen his birth records and they miraculously leave out the whole event as well. I understand he panicked and just wanted to get the baby out, but who is to say what would of happened if he left the cord alone, I will never know.